Workers Compensation Claims Examiner - Jurisdiction: Midwest - Licensing Required: TX or IN (Hybrid)

Sedgwick; Omaha (NE); Hybrid; USD 70,000 - 95,000; Full time

Benefits offered by this job

Medical, dental, vision benefits

401K on day one

Referral incentive program

Hybrid work arrangement

Career development opportunities

Job summary

Sedgwick, a global leader in claims management, seeks a Workers' Compensation Claims Examiner for a hybrid Midwest role in Omaha. You will analyze complex claims, determine benefits due, and ensure adjudication meets client service expectations.

Ideal candidates have a Bachelor's degree, five years of claims experience, strong negotiation and communication skills, and ability to manage reserves and litigation. Sedgwick offers growth, flexible work, and comprehensive benefits.

Qualifications

• Bachelor's degree from an accredited college or university required.
• Five years of claims management experience or equivalent.
• Strong knowledge of insurance principles and laws for the line of business.

Responsibilities

• Analyze and process complex workers' compensation claims and determine exposure.
• Negotiate settlements within designated authority.
• Calculate reserves and manage reserves throughout the life of the claim.
• Prepare state filings within statutory limits.
• Manage litigation process and cost-effective resolutions.
• Coordinate vendor referrals for investigation or litigation management.
• Manage claim recoveries including subrogation and offsets.

Skills

Oral and written communication

Analytical skills

Interpersonal skills

Negotiation skills

Organizational skills

Teamwork

Microsoft Office

Education

Bachelor's degree

Professional certification (as applicable)

Job description

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance

Workers Compensation Claims Examiner | Jurisdiction: Midwest | Licensing Required: TX or IN (Hybrid)

Workers Compensation Claims Examiner

Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights. Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.

ARE YOU AN IDEAL CANDIDATE?

We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

WORK LOCATIONS

Hybrid Role - 2 days in office Office located in Omaha, NE or West Des Moines, IA

PRIMARY PURPOSE OF THE ROLE

To analyze claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements .

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

• Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
• Negotiates settlement of claims within designated authority.
• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
• Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
• Prepares necessary state fillings within statutory limits.
• Manages the litigation process; ensures timely and cost effective claims resolution.
• Coordinates vendor referrals for additional investigation and/or litigation management.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
• Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.

QUALIFICATION

Education & Licensing

• Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

Experience

• Five (5) years of claims management experience or equivalent combination of education and experience required.

Skills & Knowledge

• Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Good interpersonal skills
• Excellent negotiation skills
• Ability to work in a team environment
• Ability to meet or exceed Service Expectations

TAKING CARE OF YOU

• Flexible work schedule.
• Referral incentive program.
• Opportunity to work in an agile environment. [If Applicable]
• Career development and promotional growth opportunities.
• A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

WORK ENVIRONMENT REQUIREMENTS INCLUDE

• Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
• Physical: Computer keyboarding, [travel as required (leave travel statement only if applicable)]
• Auditory/Visual: Hearing, vision and talking

NOTE

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of sta